Electronic health record
An electronic health record (EHR) is an evolving concept, "defined as a longitudinal collection of electronic health information about individual patients and populations." It is a record in digital format that is theoretically capable of being shared across different health care settings. In some cases this sharing can occur by way of network-connected enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.
EMR vs. EHR
In 2006, the Healthcare Information and Management Systems Society (HIMSS) noted in its white paper Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference "electronic medical record" (EMR) and "electronic health record" (EHR) are "completely different concepts." HIMSS made the following distinctions for the two:
- electronic medical record: An application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient's electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO).
- electronic health record: A subset of each care delivery organization's EMR ... [that] is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state (or in some countries, the entire country).
In 2011 the U.S. Department of Health and Human Services (HHS) noted that despite the interchanging of the terms "EMR" and "EHR," it considers them two separate entities. The HHS notes early on in the realm of digital record keeping in healthcare, the EMR came first, used primarily by medical clinicians for diagnosis and treatment. However, the concept evolved, and the EHR came into existence as a more holistic, inclusive collection of a patient's health data, "designed to reach out beyond the health organization that originally collects and compiles the information." The HHS notes how the EHR "moves with the patient — to the specialist, the hospital, the nursing home, the next state or even across the country," while "information in EMRs doesn't travel easily out of the practice."
Grasping a more global view of the differences between EMR and EHR is a bit more difficult. Definitions may vary somewhat from country to country, and market and scientific researchers may differ in their own distinction between the two. For example, the global management consulting, technology services, and outsourcing company Accenture made little distinction — with the exception of a footnote — between "EMR" and "EHR" in a 2010 study on worldwide healthcare software, focusing heavily on the use of "EMR;" whereas the Commonwealth Fund in their 2012 research emphasized the term "EHR."
Gartner, a global information technology research and advisory company, defines the terms in the following way (substituting "computer-based patient record" (CPR) for "EMR"):
- electronic medical record or computer-based patient record: a system that contains electronically maintained information about an individual's health status and care. It focuses on tasks directly related to patient care, unlike other healthcare information systems that support providers' and payers' operational processes (which may, however, serve as source or feeder systems for the CPR). The CPR completely replaces the paper medical chart and thus must meet all clinical, legal and administrative requirements.
- electronic health record: a system [that] contains patient-centric, electronically maintained information about an individual's health status and care, focuses on tasks and events directly related to patient care, and is optimized for use by clinicians. The EHR provides support for all activities and processes involved in the delivery of clinical care. The definition of an EHR system limits its scope to the continuum of care in one [health care delivery organization].
Before researchers of the Commonwealth Fund and its associated International Program in Health Policy and Innovation could set out to survey doctors around the world about their EHR systems, a set of criteria had to be developed for what constitutes a multi-functional EHR. At least two out of the follow four criteria had to be met:
- the system generated patient information, such as lists of patients' medications
- the system generated a patient registry and panel information, such as a list of patients due for preventive care
- the system had order entry management, such as electronic prescribing
- the system had decision support, such as alerts about potential adverse drug interactions
The authors of the 2012 survey also noted "the ability of doctors to exchange clinical summaries and lab results electronically 'is not yet the norm in any country.'"
- Gunter, T.D.; Terry, N.P. (Jan–Mar 2005). "The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models, Costs, and Questions". Journal of Medical Internet Research 7 (1). doi:10.2196/jmir.7.1.e3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550638/. Retrieved 08 May 2013.
- Garets, Dave; Davis, Mike (26 January 2006). "Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference". HIMSS Analytics, LLC. http://www.himssanalytics.org/docs/wp_emr_ehr.pdf. Retrieved 08 May 2013.
- Garrett, Peter; Seidman, Joshua (04 January 2011). "EMR vs EHR – What is the Difference?". Health IT Buzz. U.S. Department of Health and Human Services. http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/. Retrieved 08 May 2013.
- [http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_EMR_Markets_Whitepaper_vfinal.pdf "Overview of International EMR/EHR Markets - Results from a Survey of Leading Health Care Companies"]. Accenture plc. August 2010. http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_EMR_Markets_Whitepaper_vfinal.pdf. Retrieved 08 May 2013.
- Terry, Ken (15 November 2012). "EHR Adoption: U.S. Remains The Slow Poke". Information Week. http://www.informationweek.com/healthcare/electronic-medical-records/ehr-adoption-us-remains-the-slow-poke/240142152. Retrieved 08 May 2013.
- Schoen, Cathy; Osborn, Robin; Squires, David; Doty, Michelle; Rasmussen, Petra; Pierson, Roz; Applebaum, Sandra. "A Survey Of Primary Care Doctors In Ten Countries Shows Progress In Use Of Health Information Technology, Less In Other Areas". Health Affairs 31 (12): 2805–16. doi:10.1377/hlthaff.2012.0884. http://content.healthaffairs.org/content/early/2012/11/13/hlthaff.2012.0884.
- Lazarus, Ian R.; Gabler, James M.. "Before they can realize their true potential, EMRs must be the carefully defined product of a multidisciplinary effort". Creative Healthcare. http://www.creative-healthcare.com/Electronic-Medical-Record. Retrieved 08 May 2013.
- "CPR (computer-based patient record)". Gartner, Inc. http://www.gartner.com/it-glossary/cpr-computer-based-patient-record/. Retrieved 08 May 2013.
- "Electronic Health Record (EHR)". Gartner, Inc. http://www.gartner.com/it-glossary/ehr/. Retrieved 08 May 2013.